Provider Demographics
NPI:1790959146
Name:SYDNEY Z SPIESEL PHD MD LLC
Entity Type:Organization
Organization Name:SYDNEY Z SPIESEL PHD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SPIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:203-397-5211
Mailing Address - Street 1:8 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2352
Mailing Address - Country:US
Mailing Address - Phone:203-397-5211
Mailing Address - Fax:203-397-1875
Practice Address - Street 1:8 LUNAR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2352
Practice Address - Country:US
Practice Address - Phone:203-397-5211
Practice Address - Fax:203-397-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty